Williams’s analysis “at first glance” is correct—orlistat works and is safe, and people should be free to spend their money as they wish.1 His subsequent caveats have no merit.

It is true that that users may see less benefit than the hoped for loss of 10% of their weight, that they may abandon the drug altogether, or avoid it when about to eat fish and chips. That is their choice and their problem. The medical profession doesn’t have a monopoly of knowledge about the input-output logic of weight control—most people, even we fat people, can read, and we are all bombarded on a daily basis with messages about exercise and other forms of “lifestyle modification.”

Removing 100 kcal per day from the equation is not irrelevant. Many people become overweight, not because they binge on six hamburgers a day and eat ice cream in the middle of the night, but because over a period of years they steadily ingest every day a few calories more than they use up. A drug that tips that balance, even marginally, has the potential to provide more encouragement for accompanying dietary control and exercise than any amount of medical supervision.

This medical supervision that is supposed to save foolish patients from their unrealistic expectations is in fact something that many overweight people will do a great deal to avoid, having, in past encounters, been met with thinly-veiled disgust and no effective help. The medical profession doesn’t have a great record of success in this matter and should not be restricting access to a safe drug that may help people to help themselves.